Understanding psychological treatment for psychosis from the perspective of those with lived ...

319 Pages·2014·2.45 MB·English

by  Rory Byrne

Understanding psychological treatment for psychosis
from the perspective of those with lived experience:
‘What’s important to us?’

A thesis submitted to the University of Manchester for the degree of
Doctor of Philosophy
in the Faculty of Medical and Human Sciences

2014

Rory Byrne
School of Psychological Sciences
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CONTENTS
List of Tables ............................................................................................................................ 7
List of Appendices .................................................................................................................... 7
List of Abbreviations ................................................................................................................ 8
Abstract .................................................................................................................................. 11
Declaration ............................................................................................................................. 12
Copyright statement .............................................................................................................. 12
Acknowledgements ................................................................................................................ 14
The Author ............................................................................................................................. 15
Chapter 1: Literature review: Understanding psychological treatment for psychosis from
the perspective of those with lived experience ..................................................................... 16
1.1 Overview ...................................................................................................................... 16
1.2 Understanding psychosis ............................................................................................. 19
1.2.1 The biomedical model of psychosis ...................................................................... 20
1.2.1.1 Genetic inheritance ........................................................................................ 20
1.2.1.2 Neurophysiology ............................................................................................ 22
1.2.1.3 The dopamine hypothesis .............................................................................. 23
1.2.1.4 The biomedical approach: helpful, or harmful? ............................................ 24
1.2.2 The stress-vulnerability model of psychosis ......................................................... 27
1.2.2.1 Environmental influences on psychosis ......................................................... 28
1.2.2.2 Social influences on psychosis ....................................................................... 29
1.2.2.3 Trauma and psychosis .................................................................................... 30
1.2.3 Psychological models of psychosis ........................................................................ 33
1.2.3.1 Attachment theory ......................................................................................... 34
1.2.3.2 Family models ................................................................................................ 37
1.2.3.3 Psychodynamic theory ................................................................................... 39
1.2.3.4 Dissociation .................................................................................................... 41
1.2.3.5 Recovery style ................................................................................................ 42
1.2.3.6 Coping styles and strategies .......................................................................... 43
1.2.3.7 Cognitive behavioural models of psychosis ................................................... 46
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1.2.3.7.1 Cognitive biases ...................................................................................... 48
1.2.3.7.2 Self-concept and self-esteem ................................................................. 49
1.2.3.7.3 Safety-seeking behaviours ...................................................................... 50
1.2.4 Psychosis and stigma ............................................................................................ 52
1.2.5 Normalisation of psychosis ................................................................................... 56
1.2.6 Recovery ................................................................................................................ 58
1.3 Treatment of psychosis ................................................................................................ 60
1.3.1 Antipsychotic medication ..................................................................................... 60
1.3.1.1 Adverse effects of antipsychotic medication ................................................. 63
1.3.2 Hospitalisation ...................................................................................................... 65
1.3.3 Psychological and psychosocial interventions ...................................................... 68
1.3.3.1 CBT for psychosis ........................................................................................... 69
1.3.3.2 Adverse effects of CBT ................................................................................... 70
1.3.4 Additional and alternative treatment approaches ............................................... 74
1.3.4.1 Residential alternatives to psychiatric hospitalisation (the ‘Soteria’ paradigm)
................................................................................................................................... 74
1.3.4.2 Peer support services ..................................................................................... 76
1.3.4.3 Hearing Voices groups ................................................................................... 79
1.3.4.4 Vocational rehabilitation ............................................................................... 82
1.4 Early Detection and Intervention for psychosis ........................................................... 85
1.4.1 Early Intervention for psychosis ............................................................................ 85
1.4.2 Early Detection of psychosis ................................................................................. 88
1.4.3 Potential adverse effects of Early Detection and Intervention ............................ 90
1.5 Qualitative research and subjective experiences of psychosis .................................... 91
1.5.1 Overview ............................................................................................................... 92
1.5.2 Qualitative studies exploring Early Intervention for psychosis ............................ 93
1.5.2.1 Qualitative research in Early Detection for psychosis ................................... 94
1.5.3 Qualitative research into CBT for psychosis ......................................................... 94
1.5.4 An overview of qualitative methods ..................................................................... 96
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1.6 Service user involvement in mental health research................................................... 99
1.6.1 Background and rationale for service user involvement .................................... 100
1.6.2 The role of the user-researcher .......................................................................... 101
1.7 Service users’ priorities and preferences for treatment of psychosis ....................... 104
1.8 Summary and rationale for this thesis ....................................................................... 106
1.9 Aims and objectives of this thesis .............................................................................. 108
Chapter 2: Priorities and preferences for the outcomes of treatment of psychosis: A service
user perspective ................................................................................................................... 111
2.1 Abstract ...................................................................................................................... 112
2.2 Background ................................................................................................................ 113
2.3 Method ...................................................................................................................... 115
2.4 Results ........................................................................................................................ 116
2.4.2 Outcome priorities and valued outcomes of people with psychosis .................. 116
2.4.3 Preferences for treatment of psychosis .............................................................. 119
2.5 Discussion ................................................................................................................... 121
Chapter3: Service users’ priorities and preferences for treatment of psychosis: A user-led
Delphi study ......................................................................................................................... 124
3.1 Abstract ...................................................................................................................... 125
3.2 Introduction ............................................................................................................... 126
3.3 Methods ..................................................................................................................... 128
3.4 Results ........................................................................................................................ 130
3.5 Discussion and conclusions ........................................................................................ 131
3.6 Acknowledgements and disclosures .......................................................................... 133
Chapter 4: Young people at risk of psychosis: a user-led exploration of interpersonal
relationships and communication of psychological difficulties ........................................... 134
4.1 Abstract ...................................................................................................................... 135
4.2 Introduction ............................................................................................................... 136
4.3 Method ...................................................................................................................... 139
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4.3.1 Participants ......................................................................................................... 140
4.3.2 Procedure ............................................................................................................ 141
4.3.3 Data analysis ....................................................................................................... 142
4.4 Results ........................................................................................................................ 142
4.4.1 Difficulty with interpersonal relationships and reduced opportunities for
communication ............................................................................................................ 143
4.4.2 Reluctance to disclose unusual psychological problems .................................... 144
4.4.3 Disclosure of unusual psychological problems: costs and benefits .................... 146
4.5 Discussion ................................................................................................................... 147
4.5.1 Methodological considerations .......................................................................... 150
4.5.2 Clinical implications............................................................................................. 151
4.6 Acknowledgements .................................................................................................... 153
Chapter 5: Exploring Service Users’ Perceptions of Cognitive Behavioural Therapy for
Psychosis: A User Led Study ................................................................................................. 154
5.1 Abstract ...................................................................................................................... 155
5.2 Introduction ............................................................................................................... 156
5.3 Method ...................................................................................................................... 158
5.3.1 Participants ......................................................................................................... 158
5.3.2 Design, procedure and analysis .......................................................................... 159
5.4 Results ........................................................................................................................ 160
5.4.1 CBT as a process of person-centred engagement .............................................. 161
5.4.2 CBT as an active process of structured learning ................................................. 164
5.4.3 CBT helping to improve personal understanding ............................................... 167
5.4.4 CBT is hard work ................................................................................................. 169
5.4.5 CBT and recovery ................................................................................................ 172
5.5 Discussion ................................................................................................................... 176
5.6 Acknowledgements .................................................................................................... 182
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Chapter 6: Young people at risk of psychosis: Their subjective experiences of monitoring
and cognitive behaviour therapy in the EDIE 2 trial ............................................................ 183
6.1 Abstract ...................................................................................................................... 184
6.2 Introduction ............................................................................................................... 186
6.3 Method ...................................................................................................................... 188
6.3.1 Participants ......................................................................................................... 188
6.3.2 Procedure ............................................................................................................ 190
6.3.3 Interviews ............................................................................................................ 190
6.3.4 Analysis ............................................................................................................... 191
6.4 Results ........................................................................................................................ 192
6.4.1 ‘A chance to talk’ ................................................................................................. 192
6.4.2 Monitoring .......................................................................................................... 196
6.4.3 CBT ...................................................................................................................... 199
6.5 Discussion ................................................................................................................... 203
6.5.1 Comparison with existing research ..................................................................... 204
6.5.2 Methodological Limitations ................................................................................ 207
6.5.3 Clinical Implications ............................................................................................ 208
Chapter 7: Discussion ........................................................................................................... 211
7.1 Summary of study findings ........................................................................................ 211
7.2 Integration of themes across studies ......................................................................... 214
7.3 Comparison with existing literature .......................................................................... 215
7.4 Limitations of studies ................................................................................................. 219
7.4.1 Potential researcher bias .................................................................................... 228
7.5 Strengths of the research ........................................................................................... 234
7.6 Clinical implications ................................................................................................... 236
7.7 Future research .......................................................................................................... 239
7.8 Conclusions ................................................................................................................ 243
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References ........................................................................................................................... 245
Appendices ........................................................................................................................... 284

Word Count: 74, 400
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List of Tables
Table 1. Outcome priorities and valued outcomes of people with psychosis ......... 117
Table 2. Statements about treatment priorities and preferences endorsed by service
users in a Delphi study ............................................................................................. 130
Table 3. Qualitative study of CBT for psychosis: Super-ordinate and subordinate
themes (including number of participants endorsing each) .................................... 160

List of Appendices
Appendix 1. Chapter 3: Delphi study of priorities and preferences for treatment of
psychosis: participant characteristics ...................................................................... 284
Appendix 2. Chapter 3: Delphi study of priorities and preferences for treatment of
psychosis: group consensus ratings for items included in final statement set ....... 286
Appendix 3. Chapter 3: Delphi study of priorities and preferences for treatment of
psychosis: group consensus ratings for items not included in final statement set . 287
Appendix 4. Chapter 3: Participant Information Sheet ........................................... 292
Appendix 5. Chapter 3: Consent Form ..................................................................... 296
Appendix 6. Chapter 4: Participant Information Sheet ........................................... 297
Appendix 7. Chapter 4: Consent Form ..................................................................... 299
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Appendix 8. Chapter 4: Interview Topic Guide ........................................................ 300
Appendix 9. Chapter 5: Participant Information Sheet ........................................... 303
Appendix 10. Chapter 5: Consent Form ................................................................... 306
Appendix 11. Chapter 5: Interview Schedule ........................................................... 308
Appendix 12. Chapter 6: Participant Information Sheet ......................................... 310
Appendix 13. Chapter 6: Consent Form ................................................................... 313
Appendix 14. Chapter 6: Interview Topic Guide ...................................................... 315

List of Abbreviations
ACTION: Assessment of Cognitive Therapy Instead Of Neuroleptics
ARMS: At Risk Mental State
BABCP: British Association of Behavioural and Cognitive Psychotherapies
BLIPS: Brief Limited Intermittent Psychotic Symptoms
CAARMS: Comprehensive Assessment of At Risk Mental States
CAMHS: Child and Adolescent Mental Health Service
CBT: Cognitive Behavioural Therapy
CBTp: Cognitive Behavioural Therapy for Psychosis
CFT: Compassion Focused Therapy
CMHN: Community Mental Health Nurse
CMHT: Community Mental Health Team
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CONSORT: Consolidated Standards of Reporting Trials
CR: Cognitive Remediation
CT: Cognitive Therapy
DSM: Diagnostic and Statistical Manual of Mental Disorders
DUP: Duration of Untreated Psychosis
ED: Early Detection
EDIE: Early Detection and Intervention Evaluation
EDIT: Early Detection and Intervention Team
EE: Expressed Emotion
EI: Early Intervention
EIS: Early Intervention Service
FE: First Episode
FI: Family Intervention
GP: General Practitioner
GT: Grounded Theory
HPA: Hypothalamic-Pituitary-Adrenal (axis)
HVG: Hearing Voices Groups
HVN: Hearing Voices Network
ICD: International Statistical Classification of Diseases and Related Health Problems
IEPA: International Early Psychosis Association
IPA: Interpretative Phenomenological Analysis
IPS: Individual Placement and Support
JTC: Jumping To Conclusions